Psychosomatic Medicine 1:118-137 (1939)
© 1939 American Psychosomatic Society

Blood Pressure and Palmar Sweat (Galvanic) Responses of Psychotic Patients before and after Insulin and Metrazol Therapy

A Physiologic Study of "Resistant" and Cooperative Attitudes

¹ Assistant Professor of Psychiatry, Psychiatric Institute, University of Illinois College of Medicine
² Research Psychologist, Institute for Juvenile Research, and Associate in Physiology, University of Illinois College of Medicine
³ Resident in Psychiatry, Psychiatric Institute, University of Illinois College of Medicine

Simultaneous records of systolic blood pressure and palmar galvanic (sweating) responses during a standardized psychiatric interview situation revealed correlations between autonomic reactions and psychologic "resistance." When data on reactions of the two differently innervated autonomic effectors were plotted on two-dimensional graphs, "autonomograms," it was possible to deduce events in the autonomic system which were conceivably related to the patients' resistant attitudes.

One group of patients manifesting before pharmacologic treatment an attitude of psychologic resistance involving hostility toward the examiner or toward the testing situation was characterized by large blood-pressure reactions and small galvanic responses to crucial ideational stimuli.

Another group of patients manifesting an attitude of psychologic resistance involving perplexity in discussing or evading their emotional problems likewise showed large blood-pressure reactions and small galvanic responses to these stimuli.

Following pharmacologic treatment and clinical recovery in both these groups of patients the autonomic responses were altered to show unchanged blood pressure and larger palmar galvanic changes.

Patients whose resistant attitudes persisted and were unchanged by treatment revealed no change in the character of their autonomic responses.

Patients who were overtly passive and cooperative before and after treatment showed large blood pressure changes and large galvanic responses before treatment and these remained unchanged after treatment.

On the basis of known physiologic facts underlying interpretation of the autonomogram it is inferred that large blood-pressure and small galvanic responses in resistant patients indicate selective neural or humoral inhibitory effects upon certain autonomic mechanisms. It is inferred that improvement or recovery involves a decrease in these inhibitory effects and favors increased sympathetic reactions in combination with, and partially balanced by greater cholinergic responses to ideational stimuli.

Continuous recording of autonomic changes during insulin shock treatment revealed wide relatively rapid oscillations in blood pressure which may be significant in interpreting effects on the autonomic and vascular systems.

We are indebted to Drs. H. Douglas Singer and Paul L. Schroeder for rendering the facilities respectively of the Illinois Psychiatric Institute and the Institute for Juvenile Research available for this research. We are also indebted to the Illinois Department of Public Welfare, to members of the staff who gave assistance, and to Mrs. M. Wright under W.P.A. for stenographic assistance.

Note:

Studies from the Psychiatric Institute of the University of Illinois and State Department of Public Welfare and from the Institute for Juvenile Research, Series C No. 288. Presented June 9, 1938 before the American Psychiatric Association in San Francisco. The study included two cases treated by Dauerschlaf.